Proceedings of the 26th Annual International Conference of the IEEE EMBS

San Francisco, CA, USA • September 1-5, 2004

A Mobile Tool for Accessibility and Usability Testing of Medical

Instrumentation
Melissa R. Lemke1, Jack M. Winters1, Sarma Danturthi1, Sean Campbell1,
Molly Follette Story2, Alan Barr2 and David M. Rempel2
1
Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
2
Ergonomics Laboratory, University of California, Richmond, CA, USA

Abstract—The Mobile Usability Lab (MU-Lab) is a tool hardware and software that is coordinated by a Protocol
developed by the Rehabilitation Engineering Research Center Manager that helps facilitate problem identification,
on Accessible Medical Instrumentation (RERC-AMI) to study evaluation planning, data collection and data analysis across
the accessibility and usability of medical devices by people with the continuum of the medical instrumentation utilization
diverse abilities. The system includes a suite of data collection
hardware components and a custom software interface to help
process. It has been specifically designed for detailed multi-
coordinate problem identification and planning as well as data site product accessibility and usability analysis that can be
collection and analysis for usability and accessibility research conducted at a diversity of locations in the greater
of medical devices. Hardware components include a laptop Milwaukee area (based at Marquette University) and San
computer, data acquisition card, video cameras, quad video Francisco Bay area (based at the University of California
processor and wireless microphones. Software components Ergonomics Lab).
include a customized web-based usability suite, real-time data
collection package and several video editing and data analysis II. METHODOLOGY
tools.
Fig. 1 shows the MU-Lab, which was developed to meet
Keywords—Accessibility, accessible design, ergonomics, design criteria that were established by the multi-site team.
medical instrumentation, universal design, usability The team took advantage of expertise in universal design
principles, ergonomics, usability analysis methods and
I. INTRODUCTION accessible design, while communicating through email,
Access to healthcare services by patients and telephone and bimonthly videoconference meetings for over
practitioners with disabilities is often limited by current a one-year period. An iterative process was used to develop
designs and installations of medical instrumentation. People the MU-Lab to meet the design specifications set by the
with disabilities can require more frequent healthcare team while extensive hardware and software evaluations
examinations but they may face barriers to these services were performed to determine the optimal solution to meet
that prevent them from receiving adequate care. Some of the particular needs of the RERC-AMI.
these barriers include inaccessible healthcare facilities,
inaccessible examination equipment and communication
barriers between healthcare providers and patients [1].
Healthcare providers of all abilities can also benefit from
more accessible and usable instrumentation designs, so
improvements would affect many individuals involved in
the field of healthcare service and delivery. Thus,
accessibility and usability analysis of medical
instrumentation has become an important area of research
that will offer design improvements to help minimize the
barriers to healthcare services by patients and providers with
disabilities.
The Mobile Usability Lab (MU-Lab) is a tool developed
by the Rehabilitation Engineering Research Center on
Accessible Medical Instrumentation (RERC-AMI) for
accessibility and usability analysis of medical devices by
individuals with diverse abilities. The medical
instrumentation classes of interest include diagnostic,
procedural and therapeutic equipment as well as assistive
devices that may involve a patient encounter, provider
interaction or both [2]. The MU-Lab is an all-inclusive
mobile research lab that has been designed for use in
multiple environments, instead of a specifically established
research setting. The system integrates data collection
Fig. 1. Mobile Usability Lab (within suitcase)

0-7803-8439-3/04/$20.00©2004 IEEE 4920

 The MU-Lab was designed to be portable, lightweight, SVDA™ currently supports one video input source so a
reliable and easy-to-use. Specifically, all of the hardware color quad processor is used to collect up to four video
components required for accessibility and usability analysis streams into one composite output. The quad processor
fit into one airline regulation rolling carry-on suitcase, supports any camera with a standard RCA cable output and
whereas the laptop computer is carried in a separate case it uses an RCA to USB adapter cable for inputting the
that can be placed within the larger case if desired. A rigid composite video stream into the laptop computer. (The quad
plastic shell protects the outer perimeter of the suitcase from processor is a purely plug-and-play component, so no
compressive forces and a custom antistatic polyethylene software is required for its use.) Several display options are
foam insert securely holds the hardware components so they available with the quad processor, including any single
are adequately protected during travel. (The system, in its video feed, any two video feeds via Picture-in-Picture (PIP)
suitcase, has been successfully transported both as a carry- or up to four video feeds within a quadrant display. A
on and as checked airline baggage.) Labels on the foam remote control is available for adjusting the quad processor
insert indicate the placement of each of the components functions, including the display options, time and date
within the suitcase and the Pocket Inventory, System display and individualized channel labeling for identifying
Diagram, User’s Manual and Quick Start documents guide any or all of the single video feeds.
the user through the system setup and breakdown processes. A data acquisition card is required for SVDA™ to
The software components include a customized web- function properly and it provides an interface for the
based tool that helps guide and coordinate the multi-site collection of sensor signals (e.g. contact sensors,
research team and on-site experimenters through all stages electromyography (EMG) and force transducers). The
of the experimental procedure, including universal design wireless video cameras also have the ability to detect the
analysis and test subject questionnaires. infrared (IR) bandwidth, so IR-LED video signaling is
available for the collection of minimally obtrusive switch-
based event detection in the field.
III. RESULTS
TABLE 1
MU-LAB HARDWARE COMPONENTS
A. Hardware Components
Hardware Component Description
A complete list of the hardware components included in
Laptop Computer System requirements: Windows
the MU-Lab and a brief description of each item is shown in 95/98/ME/NT/2000/XP, DirectX7 to
Table 1 and a schematic is shown in Fig.2. Several models DirectX9, Analog or digital video sources
of wireless video cameras are included in the MU-Lab so (e.g. USB, IEEE1394), National
the user can select the most appropriate model(s) for their Instruments supported data acquisition card
research (i.e. 44x-zoom/pan/tilt, 60-degree field of view and and drivers and adequate hard drive space
for video and data files
120-degree wide-angle field of view models). Each camera
National Instruments Provides the interface for sensor input into
is equipped with a standard mounting screw threading so it Data Acquisition Card the laptop computer
can be easily attached to any camera stand. Several camera
Color Quad Processor Compiles 4 separate video input signals into
stands are included in the MU-Lab, including tabletop one composite video output
tripods, lightweight tripods of different heights and a 3 Vanguard 44x Color wireless or tethered video camera
degree-of-freedom clamping arm that can secure a camera to zoom/pan/tilt Camera
most round or flat surfaces. The zoom/pan/tilt camera can be X10 XCam2 Camera 60 degree field of view color wireless
used either wirelessly or tethered, in case of environmental video camera
conditions that degrade the quality of the wireless signal or X10 XCam2 Wide 120 degree field of view wide angle
when wireless communication is prohibited within the Eye Camera wireless video camera
research setting. A remote control is available for adjusting X10 Wireless Video 2.4 GHz wireless Radio Frequency (RF)
the advanced features of the zoom/pan/tilt camera such as Receiver video receiver
automatic or manual focus, zooming, panning, tilting and Wireless Microphone Discrete two-channel VHF microphone
Receiver receiver
iris adjustments.
Audio capture is conducted via a 2-channel wireless Wireless Microphone Wireless lapel microphone
Transmitter
microphone system, which communicates through the
Manfrotto Micro Compact tripod with height range of 13 to
microphone port of the laptop computer. The wireless Tripod 714SHB 47 inches
microphone system operates in the 169 to 172 MHz Manfrotto Mini Tripod with height range of 16 to 64
bandwidth, where interference is minimal. The normal Tripod 714B inches
protocol is to use one wireless microphone transmitter to Tabletop Tripods Tripod with a height range of 5 to 8 inches
capture and record an audio signal from the researcher and
the other microphone transmitter for the subject, unless
more than one subject is present (e.g. patient and provider).

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B. Software for Data Collection
Real-time data collection is available with the use of
Synchronized Video Data Acquisition software (SVDA™,
by NexGen Ergonomics Inc.), which facilitates the
simultaneous collection of video, audio and sensor data.
SVDA™ can also facilitate a wide range of real-time or
post-collection compression algorithms for the video signal,
audio signal or both. The process of post-collection
encoding can take up to 3 to 4 times the length of the video
data that was captured, thus a 30-second video segment can
take up to 2 minutes to encode. Using the post-collection
method of video compression causes the video to be initially
captured as a raw digital video file, which is saved to the
hard drive at a rate near 600 MB/minute.
C. Software for Post Processing and Data Analysis
The core tools for data analysis are Multimedia Video
Task Analysis (MVTA™ by NextGen Ergonomics Inc.) and
two video editing packages that build on Adobe Premiere:
Cannopus DVStorm2 and Matrox RT.X100.
MVTATM was designed by ergonomists and is used for
post-processing data and task analysis procedures,
specifically time and motion analyses of video recorded
activities. It helps identify events with terminal break points
during a timed activity to help perform usability analysis.
The audio, video and sensor data can all be viewed on a
single, concurrent timeline and data can be replayed at any
speed including real-time, slow motion, fast motion or
frame-by-frame in both the forward and reverse directions.
MVTA™ can also produce conventional time study reports
and report the frequency of occurrence of any particular
event, which is helpful for accessibility and usability
analyses of medical devices.
The capabilities of MVTA™ are complemented by
Cannopus DVStorm2 and Matrox RT.X100 packages,
which add a rich collection of video editing features to
Adobe Premiere such as the ability to overlay text comments
onto a video, blurring the area over a subject’s face so they
can remain anonymous, removing unwanted portions of a
video sequence and resizing of the video window.
D. Protocol Manager
A Protocol Manager (PM) is also included within the
MU-Lab to coordinate the entire accessibility and usability
analysis process. The PM is a web-based software document
and interactive form that helps guide and coordinate the
multi-site research team and on-site experimenters through
all stages of the experimental procedure, including: medical
device problem description, universal design analysis, pre-
screening and tracking of test subjects (e.g. patients and
providers), subject activity performance observations during
data collection, post-activity interview of subjects, post-
activity data analysis and comprehensive research
documentation and data tracking. The PM is implemented in
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ASP.Net, C# and XML software languages in Microsoft’s
Video Studio .Net environment and it builds on team
expertise in ergonomics and universal design of products [3].
The software is password protected and can be implemented
locally on a single computer where the data is stored onto
the computer’s hard drive or remotely via the Internet where
the data is stored directly on the network database. Several
options are available for navigating within the PM and
saving data, including a “save-and-lock” option to help
protect important data from being accidentally overwritten.
IV. DISCUSSION
The MU-Lab is used to collect audio, video and sensor
data from a patient and/or provider during the use of a
medical device and the PM coordinates the entire research
process including collecting and storing subject data related
to a particular medical device. Several RERC-AMI projects
and student Master’s thesis projects are using the MU-Lab
for accessibility and usability analyses of targeted medical
devices. Each experimental protocol includes patients and/or
practitioners with diverse abilities, which may include
sensory and/or physical disabilities. Subjects conduct
specific tasks that are required for use of the medical device
being evaluated and the MU-Lab and PM are used to plan,
collect and analyze all of the research data.
As an example, the first author (MRL) is conducting
studies related to the positioning aspects of patient
encounters with medical devices. In a 2003-04 national
survey of people with disabilities conducted by the RERC-
AMI, participants indicated a number of accessibility issues
with respect to various types of medical equipment [4]. Of
the 239 respondents to questions about examination tables,
74.5% indicated they had experienced at least moderate
difficulty when attempting to use them, while 42.4% found
them extremely difficult or impossible to use. Some specific
issues with exam tables were related to positioning,
including concerns with the height and width of the table,
safety and comfort. Other types of equipment that posed a
significant challenge for this population include x-ray
equipment, weight scales, rehabilitation and exercise
equipment as well as examination and procedural chairs. For
all of these categories, more than 50% of the respondents
indicated at least moderate difficulty with using the
equipment. Positioning is a component involved in most
interactions with any medical device, so this priority is
significant.
Overall, the data collected by this study is being used to
improve the usability of the MU-Lab, as well as to help
formulate a classification scheme for rating the accessibility
of medical devices. The Medical Access and Universal
Design Information Tool (Med-AUDIT) is a classification
scheme being developed for medical device comparison and
redesign, as related to accessibility by persons with
disabilities. The first author (MRL) is targeting the
positioning component of Med-AUDIT, which will be
supplemented by the results from the positioning studies
performed with the MU-Lab and further biomechanical
analyses.
V. CONCLUSION
The MU-Lab is a state-of-the-art system that was
designed to support detailed accessibility and usability
analyses of devices, particularly medical instrumentation.
The system integrates multiple video, audio and sensor data
collection capabilities, while providing a streamlined
approach to the coordination and management of the entire
accessibility and usability analysis process. The overall
purpose of this system is to provide an interface for multi-
site data collection and analysis, which will provide a basis
for making informed design improvement suggestions. In
the case of this project, the goal is to increase access to
healthcare services to patients who have disabilities, as well
as to increase access to employment in the healthcare
professions to practitioners with disabilities.
The MU-Lab constitutes a valuable tool for
sophisticated usability analysis that could be used by many
different disciplines including but not limited to engineering,
design and occupational studies, to help better understand
the accessibility and usability of a wide variety of devices.
ACKNOWLEDGMENT
This work is supported by the Rehabilitation
Engineering Research Center on Accessible Medical
Instrumentation, funded by the National Institute on
Disability and Rehabilitation Research, U.S. Department of
Education Grant #H133E020729.
Fig. 2. MU-Lab Hardware Schematic
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We would like to thank Dr. Roger Smith of the University
of Wisconsin-Milwaukee for helpful discussions and Drs.
Robert Radwin and Thomas Yen of the University of
Wisconsin-Madison for assistance with SVDA™ and
MVTA™.
We would also like to thank Jason Foil, Matthew
Wimmer and Melinda Winter of Marquette University for
their valuable input related to various components of the
MU-Lab as well as Dr. Jill Winters for sharing her statistical
analyses.
REFERENCES
[1] M.J. Gibson et al., Beyond 50 2003: A report to the Nation on
Independent Living and Disability, Washington, DC: AARP, 2003.
[2] M. Winter and J.M. Winters, “Access-RIM: A Proposed Classification
Scheme for Accessible Medical Instrumentation in Development,”
unpublished.
[3] M.F. Story and J. Mueller, “Universal design performance measures
for products. A tool for assessing universal usability,” in Emerging
and Accessible Telecommunications, Information and Healthcare
Technologies, J.M. Winters, C.J. Robinson, R.C. Simpson and G.C.
Vanderheiden, Eds. Arlington, VA: RESNA Press, 2002, ch. 2, pp.19-
28.
[4] J.M. Winters, M.F. Story, J.I. Kailes, B. Premo, R.S. Danturthi, J.M.
Winters, “Accessibility of Medical Instrumentation for Persons with
Disabilities: A National Survey,” Poster presented at 28th Midwest
Nursing Research Society Annual Research Conference. St. Louis,
MO, February, 2004